PEACE Tool (which assesses the Physical, Emotive, Autonomy, Communication, Economic, and Transcendent domains) is included as a table

PEACE Tool stands for:

  • Physical
  • Emotional, Psych, Mental:
  • Autonomy
  • Communication
  • Economic

and

  • Transcendent domains of quality of life.

 

PEACE* tool for symptom management in palliative care

The answers to the questions are intended to be quantified (scale 0 – 10) with the PEACE Tool Distress Thermometer.
In the past week, how much have you been bothered by or suffered from: Date/Initials
1. Pain
2. Appetite loss
3. Incontinence of bladder or bowel
4. Nausea, vomiting, constipation or other bowel problems
5. Breathing problems or cough
6. Ulcers, dryness or mouth sores
7. Lesser (diminishing) ability to carry out daily activities and functions (cleaning, showering, lifting, walking, etc.)
8. Feeling weak or tired or having low energy
9. Feeling sleepy during day and/or not sleeping at night
10. Feeling anxious, nervous, uneasy, tense or frightened
11. Feeling sad, depressed, helpless or unable to enjoy things
12. Feeling confused, restless or agitated
13. Feeling not in control of your care and/or not being understood what you want
14. Feeling not prepared for, and/or fearing what is still ahead of you
15. Feeling more need for support than your family, friends or insurance can provide
16. Feeling abandoned or punished by God or not supported by your church/faith
From the list above, which problem are you suffering the most
From the list above, which problem are you suffering the second most
Notes (are there any other problems that have bothered you recently?)
*PEACE is an acronym, which stands for the Physical; Emotive; Autonomy; Communication; Economic; and Transcendent domains of quality of life.
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